Provider Demographics
NPI:1225228927
Name:BALTZ, KATHLEEN LOIS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOIS
Last Name:BALTZ
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 W YALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3423
Mailing Address - Country:US
Mailing Address - Phone:303-691-0891
Mailing Address - Fax:
Practice Address - Street 1:7515 W YALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3423
Practice Address - Country:US
Practice Address - Phone:303-691-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics